MEDICARE: DANIEL JOSEPH SULLIVAN MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207P00000X	Emergency Medicine Physician	42965020	WI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1336132612
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DANIEL JOSEPH SULLIVAN MD

Provider Business Mailing Address
First Line	:	P.O. BOX 5990, DEPT 20-6001
Second Line	:
City	:	CAROL STREAM
State	:	IL
Zip	:	60197-5990
Country	:	US
Telephone Number	:	630-785-9100
Fax Number	:	630-785-9199

Provider Business Practice Location Address
First Line	:	1 TRANSAM PLAZA DR
Second Line	:	SUITE 360
City	:	OAKBROOK TERRACE
State	:	IL
Zip	:	60181-4822
Country	:	US
Telephone Number	:	630-785-9100
Fax Number	:	630-785-9199

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/23/2005
Last Update Date	:	12/08/2011

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Directions to “ DANIEL JOSEPH SULLIVAN MD” Practice Location

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